Antithrombotic therapy after mitral valve repair: VKA or aspirin?

Sake J. van der Wall, Jules R. Olsthoorn, Samuel Heuts, Robert J. M. Klautz, Anton Tomsic, Evert K. Jansen, Alexander B. A. Vonk, Peyman Sardari Nia, Frederikus A. Klok, Menno V. Huisman

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

The optimal antithrombotic therapy following mitral valve repair (MVr) is still a matter of debate. Therefore, we evaluated the rate of thromboembolic and bleeding complications of two antithrombotic prevention strategies: vitamin K antagonists (VKA) versus aspirin. Consecutive patients who underwent MVr between 2004 and 2016 at three Dutch hospitals were evaluated for thromboembolic and bleeding complications during three postoperative months. The primary endpoint was the combined incidence of thromboembolic and bleeding complications to determine the net clinical benefit of VKA strategy as compared with aspirin. Secondary objectives were to evaluate both thromboembolic and bleeding rates separately and to identify predictors for both complications. A total of 469 patients were analyzed, of whom 325 patients (69%) in the VKA group and 144 patients (31%) in the aspirin group. Three months postoperatively, the cumulative incidence of the combined end point of the study was 9.2% (95%CI 6.1–12) in the VKA group and 11% (95%CI 6.0–17) in the aspirin group [adjusted hazard ratio (HR) 1.6, 95%CI 0.83–3.1]. Moreover, no significant differences were observed in thromboembolic rates (adjusted HR 0.82, 95%CI 0.16–4.2) as well as in major bleeding rates (adjusted HR 1.89, 95%CI 0.90–3.9). VKA and aspirin therapy showed a similar event rate of 10% during 3 months after MVr in patients without prior history of AF. In both treatment groups thromboembolic event rate was low and major bleeding rates were comparable. Future prospective, randomized trials are warranted to corroborate our findings.
Original languageEnglish
Pages (from-to)473-481
JournalJournal of Thrombosis and Thrombolysis
Volume46
Issue number4
DOIs
Publication statusPublished - 2018

Cite this

van der Wall, S. J., Olsthoorn, J. R., Heuts, S., Klautz, R. J. M., Tomsic, A., Jansen, E. K., ... Huisman, M. V. (2018). Antithrombotic therapy after mitral valve repair: VKA or aspirin? Journal of Thrombosis and Thrombolysis, 46(4), 473-481. https://doi.org/10.1007/s11239-018-1724-0
van der Wall, Sake J. ; Olsthoorn, Jules R. ; Heuts, Samuel ; Klautz, Robert J. M. ; Tomsic, Anton ; Jansen, Evert K. ; Vonk, Alexander B. A. ; Sardari Nia, Peyman ; Klok, Frederikus A. ; Huisman, Menno V. / Antithrombotic therapy after mitral valve repair: VKA or aspirin?. In: Journal of Thrombosis and Thrombolysis. 2018 ; Vol. 46, No. 4. pp. 473-481.
@article{5bbb9289ed2e48ad9318ddc586d248b7,
title = "Antithrombotic therapy after mitral valve repair: VKA or aspirin?",
abstract = "The optimal antithrombotic therapy following mitral valve repair (MVr) is still a matter of debate. Therefore, we evaluated the rate of thromboembolic and bleeding complications of two antithrombotic prevention strategies: vitamin K antagonists (VKA) versus aspirin. Consecutive patients who underwent MVr between 2004 and 2016 at three Dutch hospitals were evaluated for thromboembolic and bleeding complications during three postoperative months. The primary endpoint was the combined incidence of thromboembolic and bleeding complications to determine the net clinical benefit of VKA strategy as compared with aspirin. Secondary objectives were to evaluate both thromboembolic and bleeding rates separately and to identify predictors for both complications. A total of 469 patients were analyzed, of whom 325 patients (69{\%}) in the VKA group and 144 patients (31{\%}) in the aspirin group. Three months postoperatively, the cumulative incidence of the combined end point of the study was 9.2{\%} (95{\%}CI 6.1–12) in the VKA group and 11{\%} (95{\%}CI 6.0–17) in the aspirin group [adjusted hazard ratio (HR) 1.6, 95{\%}CI 0.83–3.1]. Moreover, no significant differences were observed in thromboembolic rates (adjusted HR 0.82, 95{\%}CI 0.16–4.2) as well as in major bleeding rates (adjusted HR 1.89, 95{\%}CI 0.90–3.9). VKA and aspirin therapy showed a similar event rate of 10{\%} during 3 months after MVr in patients without prior history of AF. In both treatment groups thromboembolic event rate was low and major bleeding rates were comparable. Future prospective, randomized trials are warranted to corroborate our findings.",
author = "{van der Wall}, {Sake J.} and Olsthoorn, {Jules R.} and Samuel Heuts and Klautz, {Robert J. M.} and Anton Tomsic and Jansen, {Evert K.} and Vonk, {Alexander B. A.} and {Sardari Nia}, Peyman and Klok, {Frederikus A.} and Huisman, {Menno V.}",
year = "2018",
doi = "10.1007/s11239-018-1724-0",
language = "English",
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pages = "473--481",
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van der Wall, SJ, Olsthoorn, JR, Heuts, S, Klautz, RJM, Tomsic, A, Jansen, EK, Vonk, ABA, Sardari Nia, P, Klok, FA & Huisman, MV 2018, 'Antithrombotic therapy after mitral valve repair: VKA or aspirin?' Journal of Thrombosis and Thrombolysis, vol. 46, no. 4, pp. 473-481. https://doi.org/10.1007/s11239-018-1724-0

Antithrombotic therapy after mitral valve repair: VKA or aspirin? / van der Wall, Sake J.; Olsthoorn, Jules R.; Heuts, Samuel; Klautz, Robert J. M.; Tomsic, Anton; Jansen, Evert K.; Vonk, Alexander B. A.; Sardari Nia, Peyman; Klok, Frederikus A.; Huisman, Menno V.

In: Journal of Thrombosis and Thrombolysis, Vol. 46, No. 4, 2018, p. 473-481.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Antithrombotic therapy after mitral valve repair: VKA or aspirin?

AU - van der Wall, Sake J.

AU - Olsthoorn, Jules R.

AU - Heuts, Samuel

AU - Klautz, Robert J. M.

AU - Tomsic, Anton

AU - Jansen, Evert K.

AU - Vonk, Alexander B. A.

AU - Sardari Nia, Peyman

AU - Klok, Frederikus A.

AU - Huisman, Menno V.

PY - 2018

Y1 - 2018

N2 - The optimal antithrombotic therapy following mitral valve repair (MVr) is still a matter of debate. Therefore, we evaluated the rate of thromboembolic and bleeding complications of two antithrombotic prevention strategies: vitamin K antagonists (VKA) versus aspirin. Consecutive patients who underwent MVr between 2004 and 2016 at three Dutch hospitals were evaluated for thromboembolic and bleeding complications during three postoperative months. The primary endpoint was the combined incidence of thromboembolic and bleeding complications to determine the net clinical benefit of VKA strategy as compared with aspirin. Secondary objectives were to evaluate both thromboembolic and bleeding rates separately and to identify predictors for both complications. A total of 469 patients were analyzed, of whom 325 patients (69%) in the VKA group and 144 patients (31%) in the aspirin group. Three months postoperatively, the cumulative incidence of the combined end point of the study was 9.2% (95%CI 6.1–12) in the VKA group and 11% (95%CI 6.0–17) in the aspirin group [adjusted hazard ratio (HR) 1.6, 95%CI 0.83–3.1]. Moreover, no significant differences were observed in thromboembolic rates (adjusted HR 0.82, 95%CI 0.16–4.2) as well as in major bleeding rates (adjusted HR 1.89, 95%CI 0.90–3.9). VKA and aspirin therapy showed a similar event rate of 10% during 3 months after MVr in patients without prior history of AF. In both treatment groups thromboembolic event rate was low and major bleeding rates were comparable. Future prospective, randomized trials are warranted to corroborate our findings.

AB - The optimal antithrombotic therapy following mitral valve repair (MVr) is still a matter of debate. Therefore, we evaluated the rate of thromboembolic and bleeding complications of two antithrombotic prevention strategies: vitamin K antagonists (VKA) versus aspirin. Consecutive patients who underwent MVr between 2004 and 2016 at three Dutch hospitals were evaluated for thromboembolic and bleeding complications during three postoperative months. The primary endpoint was the combined incidence of thromboembolic and bleeding complications to determine the net clinical benefit of VKA strategy as compared with aspirin. Secondary objectives were to evaluate both thromboembolic and bleeding rates separately and to identify predictors for both complications. A total of 469 patients were analyzed, of whom 325 patients (69%) in the VKA group and 144 patients (31%) in the aspirin group. Three months postoperatively, the cumulative incidence of the combined end point of the study was 9.2% (95%CI 6.1–12) in the VKA group and 11% (95%CI 6.0–17) in the aspirin group [adjusted hazard ratio (HR) 1.6, 95%CI 0.83–3.1]. Moreover, no significant differences were observed in thromboembolic rates (adjusted HR 0.82, 95%CI 0.16–4.2) as well as in major bleeding rates (adjusted HR 1.89, 95%CI 0.90–3.9). VKA and aspirin therapy showed a similar event rate of 10% during 3 months after MVr in patients without prior history of AF. In both treatment groups thromboembolic event rate was low and major bleeding rates were comparable. Future prospective, randomized trials are warranted to corroborate our findings.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/30132244

U2 - 10.1007/s11239-018-1724-0

DO - 10.1007/s11239-018-1724-0

M3 - Article

VL - 46

SP - 473

EP - 481

JO - Journal of Thrombosis and Thrombolysis

JF - Journal of Thrombosis and Thrombolysis

SN - 0929-5305

IS - 4

ER -